The Challenge Of Honesty

Whether people are being dishonest about whether they have been exercising, eating healthy, or taking their medications as prescribed, many are not honest with the professionals that they have put their trust in to provide health care. Disclosing drug or alcohol abuse is no different, and if anything, it adds an additional level of anxiety for patients. It’s understandable to feel vulnerable when self-disclosing substance abuse with a primary care provider as many individuals fear judgment, being reported, or receiving mistreatment.

However, it is crucial to be completely honest with your doctor about how much you are drinking or if you are abusing any drugs. This will not only help you receive effective treatment, but may save your life.

Why Are People Dishonest About Substance Use?

Before discussing why it is a good idea to be honest about substance use with your doctor, let’s review why individuals may be dishonest in the first place.

In a recent study published in JAMA Network Open, researchers explored why some patients are not telling the truth to their healthcare providers. Their findings included:

  • 82% of patients identified as not wanting to be judged, stigmatized, or lectured.
  • 76% of patients said they didn’t want to know that what they were doing was harmful.
  • 61% of patients said they were embarrassed.

The study also found that people were more willing to be honest about their mental health symptoms to an online bot than a human face-to-face. Beyond what the study found, there are other reasons why an individual may not be honest about their substance use history with a primary care provider.

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Abusing drugs or alcohol adds additional patient motives for dishonesty. Some patients said that they:

  • Did not want their substance use included in their medical record.
  • Feared mistreatment and not getting or receiving fair medical treatment.
  • Did not want to come across as difficult.
  • Feared being reported to some authority or agency.
  • Are not ready to admit their substance misuse.
  • Did not want to take up more of the doctor’s time.
  • Disagreed with the treatment recommendation.
  • Did not understand what the doctor was saying.
  • Failed to comply with the recommended treatment plan.
  • Did not want help.

Consequences Of Dishonesty

For some of the reasons stated above, it is understandable why some people find it difficult to be honest about their substance use with their primary care provider. However, not being truthful about substance use can have significant implications and consequences on your health ranging from mild to potentially fatal. 

For example, suppose the initial assessment of a patient identifies the incorrect problem because the patient did not disclose their substance use history. In that case, this inaccurate assessment could lead to misdiagnosis and mistreatment (e.g., incorrect medications, wrong treatment plan), causing ineffective results and wasting money and time.

Here are a few examples of these implications:

  • Substance use history is directly related to your medical treatment. While this is something that people often do not want to disclose when they are admitted to the hospital, not disclosing substance use could create more health problems. For example, if you’ve been using Cocaine and are having a heart attack, certain standard treatments might actually make it worse.
  • Common mild to moderate symptoms of withdrawal from alcohol and Benzodiazepines can feel like anxiety symptoms and can even lead to panic attacks. Sometimes people obtain a mental health therapist or psychiatrist or inform their primary care provider of their symptoms without sharing information about their substance use. Not disclosing one’s substance use history can lead an individual to endure potentially ineffective treatment. Withdrawal from alcohol or Benzodiazepines can cause seizures, convulsions, and strokes, and withdrawal symptoms can be potentially fatal if not medically treated.
  • Specific drug interactions can be harmful. Some combinations make the medications stronger or weaker; some can even cancel each other out so they become ineffective.
  • If you are admitted to the hospital for an overdose, it is imperative that you share with your doctor exactly what substance you took so they can administer the proper medication to save your life.

How To Be Honest About Substance Use With Your Doctor

While being honest with your primary care provider may feel difficult, remembering the following things might make it easier:

Doctor-Patient Confidentiality:

First, you don’t have to worry that disclosing your drug use to your doctor will get you in any legal trouble. Your doctor is bound by confidentiality and can’t release your information to a third party without your permission per federal law. Additionally, a prosecutor can’t call your doctor against you in a legal trial.


The relationship with your doctor works best if you can collaborate and work as a team for your treatment. 


Your doctor may be able to provide objective feedback about the severity of your substance use and make referrals to specialists to determine the level of care that you need. 

No Surprises:

It is likely that your doctor has spent many years or decades tending to a wide variety of needs for their patients. While you may feel like your situation is too difficult or unique for a doctor to deal with, they have likely treated similar cases in the past.

Time For A Change:

If you do not feel that you can be honest with your primary care provider, it may be time for a new doctor. It is imperative that you feel comfortable and supported by your primary care provider.


Even if you do not disclose your substance use, your blood work and urine can indicate a high possibility of substance use.


To ease your anxieties about being honest about your health, you can think of your primary care provider as a scientist simply collecting data. They need to have honest answers from you in order to assess and treat the presenting concern accurately and effectively.

Put Your Health First

Disclosing substance abuse to your health care providers is imperative to effectively tending to your health. Not being honest with your primary care provider can have serious implications and consequences. Find a compassionate and knowledgeable doctor that you can trust and be honest with about your substance use history.

If you are struggling with drug or alcohol abuse, your doctor may recommend that you seek professional addiction treatment. This is meant with your best interest in mind so that you can work towards living a healthy and fulfilling life.  

If you or a loved one has an addiction and are ready to find a rehab, contact a treatment provider today to discuss treatment options.

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Dayna Smith-Slade, MAC

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  • Dayna Smith-Slade is a nationally certified Master Addictions Counselor (MAC), licensed Substance Abuse Professional (SAP), and Substance Abuse Expert (SAE) with over 29 of hands-on experience in the addiction field.

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